Want health insurance? Not so fast

Unless you’ve recently gotten married, had a child or experienced some other big life change that makes you eligible for coverage through the new marketplaces, you will likely have to wait until this fall to get coverage.

Across the country, the year-round individual health insurance market effectively no longer exists. Insurers are embracing the protection provided by the open enrollment period under Obamacare and employer-provided plans.

For decades, large employer-sponsored and group health insurance plans have used open enrollment as a safeguard for their bottom lines, said Hans Leida, an actuary at Seattle-based Milliman, an actuarial and consulting firm.

“The rationale is that you want to restrict the ability of people who wait until they get sick or need health insurance to buy it,” Leida said.

That makes selling plans outside of open enrollment a “big risk” for insurers, he said.

“The main risk is that they would be the only one that decides to continue selling plans,” Leida said.

Doing so could position an insurer to take on a large number of mostly unhealthy customers with higher costs.

“These are the kinds of scenarios that insurers have to think about as they decide whether offer coverage outside of open enrollment,” Leida said. “It’s really a balancing act to make sure people have access while making sure the system as whole can function over time.”

In most states, the open enrollment period to buy an insurance plan through the new online insurance marketplace, or otherwise, ended on March 31. Consumers who ran into website glitches in the 36 states in which the federal government runs the new exchanges, including Ohio, were given until April 15 to complete the enrollment process.

In Ohio, Anthem Blue Cross and Blue Shield, Humana, UnitedHealthcare and Cincinnati-based HealthSpan have all said that they will sell plans only to individuals who have a qualifying event.

“There are lots of ways that someone’s life could change that would make them eligible,” said Liz Vogel, a spokeswoman for HealthSpan. “Most importantly, if someone does have a qualifying event, they can consider coverage through the marketplace where they may be eligible for a subsidy.”

Other qualifying events include changes in income, job loss or loss of insurance.

Open enrollment for 2015 coverage starts Nov. 15, 2014, and ends Feb. 15, 2015. Insurers on and off the exchanges must allow consumers to enroll in their plans during that time frame.

Before the launch of the ACA, about 48 million people, or 15 percent of the population, went without health insurance, according to the U.S. Census Bureau.

It’s still not clear how many previously uninsured people are now covered, said Mary Taylor, Ohio’s lieutenant governor and director of the state’s insurance department. Nowhere on the applications were individuals asked to disclose whether they previously had insurance, she said.

“This is a law to help uninsured people get coverage, and we’re spending trillions to do it, and we can’t answer the most relevant question: How many people were previously uninsured?” she said.

President Barack Obama announced last week that 8 million people signed up for coverage through new insurance exchanges. Nationwide, Medicaid enrollment has increased by 3 million.

Still, millions of Americans face hurdles that have prevented them from gaining coverage.

Questions of eligibility, immigrant coverage and the response from employers and state legislatures mean considerable work lies ahead for health care advocates and officials. Cost remains a particularly high hurdle for low-income people who are most likely to be uninsured.

“The ACA is the great American experiment right now,” said Dennis J. Riedmiller, CEO of the Cincinnati-based employee benefits firm Riedmiller and Associates. “I think we’re going to find out there are a lot of unintended consequences ahead. The purpose was to make health insurance more affordable and more accessible, but ... sometimes you can’t have two great things.”

Detailed federal data is expected to land any day that will offer a deeper look at just how many Americans took advantage of the first wave of health insurance enrollment.

In Ohio, 78,925 individuals had selected a new health insurance plan on HealthCare.gov through the end of February, the latest month data is available for the state.

The Associated Press and Kaiser Health News contributed to this article.

Ways to get insurance now

If you missed the open enrollment period, here are three steps you might be able to take, according to Laura Adams, a senior analyst at InsuranceQuote.com.

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People can qualify for a special enrollment period if they have a qualifying life event such as getting married or divorced, a change in family size, a change in income, relocating to a new area or losing existing health coverage. Those events entitle them to a special 60-day grace period to use the Obamacare exchanges.

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Consumers can sign up for a short-term health plan to bridge the gap until the next open enrollment in the fall. However, those plans may not meet the Affordable Care Act’s requirements for minimum essential coverage and can deny coverage based upon pre-existing conditions. As a result, policyholders may still have to pay $95 or 1 percent of their income on the 2015 income tax for lacking the right kind of health insurance.

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Medicaid and the Children’s Health Insurance Program never stop accepting enrollments.